Department of Cutaneous and Sarcoma Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, SRB4, 24012, Tampa, FL 33612, USA.
Cardiovasc Intervent Radiol. 2012 Dec;35(6):1480-7. doi: 10.1007/s00270-012-0425-x. Epub 2012 Jun 15.
Treatment of patients with unresectable liver metastases is challenging. Regional therapies to the liver have been developed that maximize treatment of the localized disease process without systemic toxic adverse effects. We discuss the procedural aspects of liver chemosaturation with percutaneous hepatic perfusion (CS-PHP).
We present as an illustration of this technique a case report of the treatment of unresectable metastatic leiomyosarcoma of the liver.
A randomized phase III trial for unresectable liver metastases from melanoma was recently completed comparing CS-PHP with melphalan vs. best alternative care (BAC). When compared with BAC, CS-PHP was associated with a significant improvement in hepatic progression-free survival (8.0 months CS-PHP vs. 1.6 months BAC, p < 0.0001) and overall progression-free survival (6.7 months CS-PHP vs. 1.6 months BAC, p < 0.0001), respectively. On the basis of these results, and given our experience as one of the treating institutions for this phase III trial, we appealed for compassionate use of CS-PHP in a patient with isolated bilobar unresectable hepatic metastases from leiomyosarcoma. Four target lesions were identified and monitored to assess treatment response. A total of 4 CS-PHP procedures were performed, with a 25 % reduction in size of the largest lesion observed and 16 month hepatic progression-free survival. Toxicity was mild (neutropenia) and manageable on an outpatient basis.
CS-PHP offers several advantages for unresectable hepatic sarcoma metastases. CS-PHP is minimally invasive and repeatable, and it has a predictable and manageable systemic toxicity profile. For appropriately selected patients, CS-PHP can delay tumor progression and could potentially improve survival.
治疗无法切除的肝转移患者具有挑战性。已经开发出针对肝脏的区域治疗方法，这些方法最大限度地治疗局部疾病过程，而不会产生全身毒性不良反应。我们讨论了经皮肝灌注（CS-PHP）肝化学饱和的程序方面。
我们提出了一个无法切除的肝转移平滑肌肉瘤的治疗病例报告，以说明该技术。
最近完成了一项针对黑色素瘤无法切除肝转移的随机 III 期试验，比较了 CS-PHP 与美法仑与最佳替代治疗（BAC）。与 BAC 相比，CS-PHP 与肝无进展生存期（CS-PHP 为 8.0 个月，BAC 为 1.6 个月，p <0.0001）和总无进展生存期（CS-PHP 为 6.7 个月，BAC 为 1.6 个月，p <0.0001）均有显著改善。基于这些结果，并考虑到我们作为该 III 期试验治疗机构之一的经验，我们呼吁在一名患有孤立性双侧无法切除的平滑肌肉瘤肝转移的患者中同情使用 CS-PHP。确定了四个靶病灶并进行监测以评估治疗反应。共进行了 4 次 CS-PHP 手术，最大病灶的大小缩小了 25%，肝无进展生存期为 16 个月。毒性轻微（中性粒细胞减少症），可在门诊基础上进行管理。
CS-PHP 为无法切除的肝肉瘤转移提供了一些优势。CS-PHP 具有微创性和可重复性，并且具有可预测和可管理的全身毒性特征。对于适当选择的患者，CS-PHP 可以延迟肿瘤进展，并可能提高生存率。
